Stress and Burnout Management during Covid-19 KNH lecture series

Dr Manasi Kumar, PhD

Department of Psychiatry

University of Nairobi

Email: m.kumar@ucl.ac.uk

1

Difference between stress and burnout

• Stress: over-engagement; when emotions are over-reactive and the demeanor is one of anxiety or hyperactivity

• Burnout: disengagement; when emotions are blunted, and the demeanor is one of depression, detachment, helplessness or hopelessness

• Even though Covid-19 is testing our capacities and abilities to provide care and to maintain our calm, we have to ensure that we do not get too burnt out and keep attending the stress as and when it flares up. If we feel burnt out, we take a pause and get others to step in or ask for support

2

Burn Out Signs

• Emotional depletion: feeling frustrated, tired of going to work, hard to deal with others at work

• Detachment/cynicism: being less empathic with patients/others, detached from work, seeing patients as diagnoses/objects/sources of frustration

• Low personal achievement: experiencing work as unrewarding, “going through the motions”

• Depersonalization: thoughts and feelings seem unreal or not belonging to oneself

3

Indicators of Burn Out- APA

• Excess stress mediated by long hours, fatigue and work compression as well as the intensity of work environment

• Loss of meaning in medicine and patient care:

• Decreased support, increased responsibility, without autonomy and flexibility

• Challenges in institutional cultures: perceived lack of peer support, lack of professionalism, disengaged leadership

• Problems with work-life balance

4

Poor Stress Response Burn Out

5

Challenge Vs Skill levels- Flow model – Mihaly Csíkszentmihályi

Model Overall guidance

• To find a balance, and to perform at our best, we need a challenge that is significant and interesting, and we need well-developed skills, so that we're confident that we can meet the challenge. This moves us to a position where we can experience "flow"

6

General risk factors for burn out related distress

• Sleep deprivation- have good quality sleep whenever possible

• High level of work/life conflict- accept what is possible and try to minimize conflicts where one can

• Work interrupted by personal concerns- address personal concerns and then focus on work, don’t continuously multitask

• High level of anger, loneliness, or anxiety- this exacerbates burn out

• Stress of work relationships- we all must make an effort to tone down negative and oppressive dynamics of work relationships

• Anxiety about competency- can hold off

• Difficulty “unplugging” after work- find ways of doing routine domestic and family activities including self care

• Regular use of alcohol and other drugs- not a good time to engage in these 7

Patient Centered Care

• Physicians who care for themselves do a better job of caring for others

• They are less likely to make errors

• Have a higher patient satisfaction

• Habits of practice to promote well-being and resilience need to be cultivated across the continuum

• A healthy learning environment will lead to improved health care for all, physicians and patients

8

Resilience – an antidote to stress and burnout

• Autonomy (perceived control over life)

• Camaraderie (social support; community)

• Opportunity for Excellence

• Being part of something meaningful

9

Developing a sense of community

• Developing a social culture and sense of belonging

• Appreciation- of what we are doing, how we can make a change and our own role in society

• Acknowledgement – of what is beyond our control, what is within our control, and of life generally

• Acceptance – of what is beyond our control, current state of affairs, of limitations posed to us by COVID-19, challenges triggered due to that

• Accommodation – adjustments made to those

10

Burn Out and Resilience

11

Burn out Management/Prevention

Burnout Management/Prevention

• Individual Provider Responsibility

• Awareness/education about burnout

• Have a plan for work-life balance

• Improve self-care and wellness

• Address professional priorities; control what you can

Health Care Organizations’ Responsibility

• Workplace culture – values, fairness, respect

• Address factors affecting wellness and career satisfaction

• Physician recognition and intervention strategies

• Mentorship – build supportive community

• Optimize EHR interface

Health Care Systems’ Responsibility

• Larger changes in practice of medicine

• Changing business models; resources and control

• Support for physicians

12

Work-life domains that beat Burn Out

13

Certain strategies to try to beat burn out

• Learn to say “No”- don’t try to be perfect

• Practice compartmentalization

• Practice leaving work related stress at work and home related stress at home

• Develop emergency coping strategies

• taking a quick break by yourself somewhere quiet

• taking a couple of deep breaths

• counting to 10 before responding

• Create your personal safe place in your home

• taking a quick break by yourself somewhere quiet

• taking a couple of deep breaths

• counting to 10 before responding

• Do something everyday that makes YOU happy

• Talk to friends outside of the workplace

• Have a little quiet time

• Keep a journal

• Exercise regularly

• Seek professional help

14

Trying a short relaxation exercise

• 5 mins